Hearing health and dementia
Authors: Jennifer A Deal, Nicholas S Reed
Journal: The Lancet Public Health (2023)

Whether hearing aids delay dementia is a pressing public health question.1Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (3359) Google Scholar In The Lancet Public Health, Fan Jiang and colleagues2Jiang F Mishra SR Shrestha N et al.Association between hearing aid use and all-cause and cause-specific dementia: an analysis of the UK Biobank cohort.Lancet Public Health. 2023; 8: e329-e338Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar recently reported that untreated hearing loss is associated with all-cause dementia risk (HR 1·42), with no increased risk among hearing aid users. In their Comment, Gill Livingston and Sergi Costafreda3Livingston G Costafreda S Preventing dementia through correcting hearing: huge progress but more to do.Lancet Public Health. 2023; 8: e319-e320Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar raise important considerations for the interpretation of these findings, including that hearing aid users could have greater economic, social, or cognitive resources than non-users. We feel there is another important consideration: when estimating the effect of hearing aids on dementia risk, what is the appropriate comparison group? Jiang and colleagues2Jiang F Mishra SR Shrestha N et al.Association between hearing aid use and all-cause and cause-specific dementia: an analysis of the UK Biobank cohort.Lancet Public Health. 2023; 8: e329-e338Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar compared dementia risk among hearing aid users who had hearing loss (ie, the exposure group) with individuals without hearing loss (ie, the reference group). However, the purpose of the reference group is to estimate the risk of the exposure group if they had not been exposed (ie, the background risk). Individuals without hearing loss do not represent the background risk for hearing aid users as they, by definition, would not be recommended nor expected to wear hearing aids. Nor are these individuals at risk of developing dementia due to untreated hearing loss. Moreover, hearing aids do not restore speech understanding to a level equivalent to individuals without hearing loss. Hearing aids are not a cure, they are rehabilitation, offering only some aid to the wearer. We propose a more appropriate reference group for people who use hearing aids is individuals with hearing loss who do not use hearing aids and encourage researchers to use this comparison group when investigating the effect of hearing aid use on dementia and other health outcomes. JAD declares a grant from the National Institutes on Aging (National Institutes of Health; grant number K01AG054693) and and honorarium from Frontiers in Epidemiology, Velux Stiftung, and Medical Education Speakers Network. NSR declares a grant from the National Institutes on Aging (grant number K23AG065443) and serves on the advisory board for Neosensory. Association between hearing aid use and all-cause and cause-specific dementia: an analysis of the UK Biobank cohortIn people with hearing loss, hearing aid use is associated with a risk of dementia of a similar level to that of people without hearing loss. With the postulation that up to 8% of dementia cases could be prevented with proper hearing loss management, our findings highlight the urgent need to take measures to address hearing loss to improve cognitive decline. Full-Text PDF Open AccessHearing health and dementia – Authors' replyIn their Correspondence, Jennifer Deal and Nicholas Reed propose that when estimating the effect of hearing aid use on dementia risk, individuals with hearing loss not using hearing aids should be an alternative reference group. Such grouping based on hearing loss might allow counterfactual assessment of the effect of hearing loss on dementia risk depending on the use (and not use) of hearing aids. In our Article,1 a reference group of people without hearing loss was compared with those with hearing loss who did or did not use hearing aids. Full-Text PDF Open AccessHearing health and dementiaFan Jiang and colleagues1 recently examined the association between hearing aid use and all-cause and cause-specific dementia in The Lancet Public Health.1 The authors observed that hearing aid use in those who self-report hearing problems appears to modify the risk of dementia. They concluded that the management of hearing loss should be treated as an urgent public health concern to improve health outcomes in later life. Full-Text PDF Open Access